ACUTE RESPONSE SCENE SAFETY AND TRIAGE IN MASS CASUALTY & - - PowerPoint PPT Presentation

ACUTE RESPONSE ‐ SCENE SAFETY AND TRIAGE IN MASS CASUALTY & DISASTERS

Dr D. SAMOO

• Ag. Director SAMU / Emergency Medicine

Wednesday 8th JUNE 2016

Soreze Incident 2013

Media reports around the world contain stories almost daily of Natural, Technological and Societal Disasters. Proliferation and access to Modern Media is 24Hr everyday. With the rapid pace of development and Climate changes Natural, Technological and Societal Disasters will continue to increase in magnitude and frequency

INFORMATION THROUGH MEDIA

Despite the affluence of United States in Disaster management, one needs not look back to far to be reminded of the lessons learnt from the destruction, human sufferings and sorrows generated by events like: Hurricane Hugo, Andrew, Lloyd, Katrina, Sandy and the terrorist attack of 11 September 2011 and the Boston Marathon Bombing which did shock the whole World. In the same vein in Mauritius, we are also not spared and cannot skip the tragic mass casualty at St Julien leaving nine death, the Montebelo episode, the recent Soreze Bus overturn and flash flood of 30 March 2013 which has drawn our concern that each disaster or major event sparks it own web and the need to identify Hazards & Build up robust EPRRC Framework is Primordial.

2016 NO COUNTRY IS IMMUNE

Probable explanations:

Inability of all stake holders to hold a common language and that’s why today’s approach to disaster Preparedness‐ Response‐ Recovery and Communications should evolve in Response to inputs from various National & International Experts of Different background (Medical, Fire‐ fighters, Police, SMF, Community Leaders, NGO’s, Press, etc.) and countries having vast experience in Disaster Management. Every stake partner should be part of the puzzle. Failure to evaluate the success and pitfall of the past and current Disaster which could yield potential information in preparing the next catastrophe. Lesson Learnt in Mauritius from previous experiences:

• Katrina : Mechanical Ventilation & Generator on Ground floor.
• Sandy : Social Medias ( Twitter, Facebook, Iphone) in Disaster.

The same incident in Soreze mass casualty where cell phone network were disturbed.

But Why do the capacity to respond to Disasters is still Optimal, despite scientific and Technological advances?

For example:

• What do we do in case of a Mass deceased fatalities? (>3000 victims in

Mauritius).

• How to stream the Elderly, Children and Handicapped in case of a Disaster?
• Why prioritize Prior Evacuation System (PES) over just‐ in‐ time evacuation

in flash flood? To date limited experience has been carried out in sensing

• flood. Satellite cannot do the work. Real time warning does not exist in flash

flood.

• What do we do in complex disaster:

Example: Complete Road Cut Off, can we rely on evacuation by Air/Sea Route/Mobile Hospital with All logistics

• What about our Surge Capacity knowing very well that it differs from

disaster to disaster?

• Has the time come to design safe Hospital in Disaster?
• Do we have legislation to shield Health Workers from Civil and criminal

liabilities in Disaster?

• What is the role of the Press and Medias? Actually should be part of the

solution instead of being part of the problem in Disaster. Responsibilities in releasing information is Primordial and should be scientifically based on expert opinion. Continuous Interaction between Press, Media and Expert in Disaster Management Essential.

Why certain aspects of Disaster management today (Clinical & Non Clinical) needs deeper reflection & anticipation?

Scientifically proved that being part of SIDS, we are much prone to Disasters. Hence by 2009, from all the lesson learnt there was an urgent need for us to toe another line with regards to Disaster Management despite having a robust EPRRC for cyclone “Hurricane”. We had to be prepared for other types of Disasters ( Mass Casualty, Flash flood, Tsunami, Chemical Spills, etc.) And Recently, we heard of mini – tornadoes

Vulnerability of Mauritius, Rodrigues and Outer Island (SIDS)

Since 2009 under aegis Of MOH & QL ‐ CDC USA several workshops to bring together all stake partners involved in Disaster Management were organized. Thankful to Dr Mark Keim Lead Consultant CDC, for his enormous effort in working together with us and come up with a Risk Priority matrix and an EPRRC Framework for Mass Casualty and other Disasters. First time in Mauritius, an EPRRC Framework linking all the thirteen Hospitals (Regional, District and specialised and at same time utilising logistics from mediclinics Area Health Centres and Community Health Centres)

STAKE PARTNERS UNDER THE SAME UMBRELLA TO HOLD A COMMON LANGUAGE

Hospital Co‐ordination Mass Casualty/Disasters

• Stratification of

Responsibilities

• Co-ordination among all

stake partners

• Pre-Hospital & Hospital

PRRC

Multiple Incident Command System (ICS)

Why?

• To Stratify Responsibilities
• Speak Common Language amongst different

stake partners.

• Good coordinating with stream line decision among all IC’s

(Field, Hospital, Control Room, Fire Services, Police, SMF, NGO, etc.)

• Good Communications (Bad Communications lead to

failure)

• Have reliable Incident Information

Different Emergency Response Organization not

• perating under an ICS = CHAOS

WHICH MODEL DO WE PRIORITIZE IN MAURITIUS?

HICS

NB: Remember 1st Information may not be correct – may need confirmation from 999, 115, Airport, Harbour, etc... MASS C SS CASUALT UALTY Y / / DISAST SASTER A ER ALERT ERT *

• 114 CR
• MEDECIN REGULATEUR (IC)
• PERMANANCIERS
• RTA – Air Crash
• Collapsed Building
• Technological, etc...
• Mass Casualty
• ACTIVATION of Intra‐Hospital EPRC

Plan by IC (RHD/MS/DM)

Inquire Types HOSPITAL concerned Inform through SMS Broadcasts

• Immediate RESPONSE by SAMU CONTROL ROOM
• Director SAMU
• RHD/ MS/DM, Police, Fire Rescue
• CEO – DGHS – DHS
• All SAMU Staff (On & Off Duty)
• HELICOPTER EVACUATION in certain specific conditions
• AMBULANCE to be despatched from A & E with

(Per Ambulance):

• Casualty Doctor x 2
• NO x 2
• Kit x 2
• Despatch nearest SAMU team
• Decision for Back up taken by MR as per feedback

from CPA by emergency physician (IC)

• Mobilise Other SAMU Team (Depending of Level)
• Alert Private Clinics
• H/A – RHD/MS/DM ensure that HELI PADs are

functional

• RHD/MS/DM/HA/HAA should ensure

that all logistics to be sent on site by CPA

• SETTING UP & TRIAGE at CPA (SAMU + HOSP Team + Private)
• MEDIA RELEASE by Director SAMU at

114

• At Hospital level by RHD

MASS CASUALTY – SAMU ACUTE RESPONSE

*Alert may be from any source.

EPRC GUIDELINES

SCENE SAFETY & MASS CASUALTY TRIAGE

• Pre – Hospital and Hospital Colour Coded TRIAGE
• Colour Coded four – category system is probably the most

common triage system adopted (Red, Yellow, Green and Black)

• Sort out victims into categories ranging from walking wounded,

salvageable, unsalvageable to the dead.

• Essential to bring a balance between Demand and supply of

existing logistics and remember that at anytime our logistics can be overwhelmed.

• Medical triage is done in Mauritius by Emergency Physician who is

the Field IC and this rule has to be firmly followed.

• Field Triage most sensitive place for coordination amongst all

stake partners ‐ Identification of Site – MOB Control‐ Cordoning

• f Zone ‐ Declaration of Scene Safety ‐ Procure Treatment are

essential.

• Hospital Triage is as important as Field Triage (for not all patients

are brought by Medical Team).

• All Stake partners should know that Paediatric Triage differ from

Adult Triage. Hence should be very caution when dealing with children.

How do we operate in Disaster?

R E D

YELLOW

GREEN B L A C K

FIRST PRIORITY MOST SERIOUSLY INJURED REQUIRE IMMEDIATE ATTENTION MAJOR INJURIES AND SHOCK. THIRD PRIORITY WALKING WOUNDED, MINOR INJURIES TREATMENT CAN WAIT TILL HIGHER PRIORITIES HAVE BEEN TREATED.

• A & E
• ICU
• Operation Theatre
• Resuscitation Room
• Outpatient Departments
• Unsorted OPD
• Ear Marked Wards

SECOND PRIORITY SIGNIFICANT INJURIES (fractures, head injuries, lacerations, etc.). TREATMENT CAN BE DELAYED CAUTION: MAY TURN RED.

• Morgue
• Other Designated

locations in case of MASS DECEASED PALLIATIVE TREATMENT DEAD OR IMMENENTLY INJURED THAT DEATH IS IMMINENT AND AVAILABLE MEDICAL CARE WILL NOT SAVE THEM.

PRE – HOSPITAL/HOSPITAL COLOR CODED TRIAGE

LOGISTICS

Field Triage & Evacuation

Hospital Preparedness & Zones

Hospital Preparedness & Zones

CONCLUSION

Always remember that our motif in Disaster Medicine and Disaster Management are:

• Do most good to most people by saving maximum life but at the

same time be clear that there is always a threshold above which we cannot proceed. The Sky is not the limit.

• In Mass deceased DEAD Bodies should be covered respectfully as

we proceed forward.

• Securing right to life with dignity is our main objective in Disaster

Medicine.

• Always handle Children with care while performing TRIAGE

because they are innocent victims who decompensate rapidly.

• Preparedness culture. Should be throughout the year supported

by TTEs, Simulation Exercises & AARs.(Never One – Off exercise, it does not serve the purpose).

• Take Home message: DNR and palliative concept in expectant

should be well understood and established in Disaster.

Air Crash Simulation

THANK YOU!